Seizure 1992;

1: 199-201

CASE REPORT

Epileptic CHRISTIAN

fits or infantile

masturbation?

HERTEL WULFF, JOHN R. 0STERGAARD

Depaflments of Clinical Neurophysiology and Pediatrics, Pediatrics, Randers Centralsygehus, Randers, Denmark Correspondence Denmark

to Dr C.H.

Wulff,

Department

of Clinical

& KIRSTEN STORM

Aarhus

Neurophysiology,

University

Aarhus

Hospital,

University

Aarhus

Hospital,

and *Department

DK-8000

Aarhus

of

C,

Two infants, one girl, 5 months old, and one boy, 6 months old, presented with rhythmic and sustained motor activities of a stereotyped nature accompanied by moaning and grunting, facial flushing and altered awareness. The episodes occurred frequently and were initially believed to be epileptic. Normal electroencephalograms during the fits, lack of response to antiepileptic medication given to one child and careful reviewing of videotape recordings, enabled us eventually to diagnose the ‘seizure-like’ episodes as masturbatory activity. Key words: epilepsy; infantile seizures; fits; masturbation;

INTRODUCTION

Any stereotyped and mental

and episodic change of motor activity raises the possibility of an

epileptic seizure, but a number of such phenomena, occurring during early childhood such as breath-holding spells, day dreaming and nightmares, are not epileptic. Sometimes, however, it may be necessary to record an electroencephalogram during one of these spells to exclude the possibility of epileptic activity. We report here two infants referred for several electroencephalograms owing to a suspicion of epileptic seizures. A diagnosis of infantile masturbation was eventually made.

CASE REPORTS

Case 1 A 5-month-old girl was referred with a 2 week history of stereotyped fits believed to be epileptic. The fits occurred only when she was lying on her back. She would flex her hips and knees, cross her legs and turn her head to one side 1059-131

l/92/030199+03

$OS~OO/O

electroencephalogram;

videotape recordings.

while she clenched her fingers. Then rhythmic contraction of her arms and legs followed, her respiration became irregular with moaning and grunting noises, and at times her face flushed with perspiration. During the spells, which could be stopped if she was picked up, she appeared distant and somewhat withdrawn. They occurred several times a day and never when she was asleep. She seemed happy and content between the episodes. She was admitted to hospital. General, ophthalmological and neurological examination was all normal. Results of a blood cell count, calcium, sugar, liver function tests, metabolic screening, urine analyses of organic acids, amino acids, norepinephrine and epinephrine, computed tomography (CT) scan of her head, ultrasound scanning of her abdomen, gastrointestinal radiography and skin examination in Wood’s light were all normal or negative. Three electroencephalograms were normal including recording with videotape during her ‘seizures’. She was treated with sodium valproate and subsequently with vigabatrin without any benefit. A diagnosis of childhood masturbation was eventually made, the antiepileptic medi@ 1992

Bailli&e

Tindall

200

cation was withdrawn reassured about the ‘habit’.

C. Hertel

and her parents were benign nature of her

Case 2

A g-month-old boy was referred with suspected epileptic fits. At 10 weeks old he was admitted with a fever and excitability. A lumbar puncture showed a pleocytosis with neutrophil and lymphocyte counts of 273 and 117 cells/mm3, respectively. A course of antibiotics was given. Five days later he was noted to have episodes of eyelid flutter and grimacing, thought to be epileptic fits. An electroencephalogram showed two independent temporal spike foci and some general slowing. Repeat spinal fluid examination 1 week later was normal and the fits stopped following a short course of phenobarbital. The electroencephalogram 4 weeks later was normal and he did well during the following months. When he was 6 months old he began to manifest a new type of ‘seizure’. When he was supine, he often stiffened his legs, slightly flexed his hips and knees, with grunting, facial flushing and sometimes rolling of the eyes. The episodes occurred many times a day and lasted from a few seconds up to several minutes, often following shortly one after the other. The ‘seizures’ had a superficial resemblance to straining, but there were no bowel movements and his bowel function was normal. He seemed content during and after the episodes without any signs of obvious distress. Sometimes his parents could divert his attention during the ‘seizures’. Two electroencephalograms, one including video recording during the episodes, were normal. A diagnosis of childhood masturbation was made and no drug treatment was given. The parents were told that the episodes were not epileptic and should be considered as a harmless habit. His psychomotor development was normal and when reviewed 6 months later, when he was 1 year old, the attacks continued but were much less frequent.

Wulff

et al.

turbatory activity shares a number of features with epileptic seizures such as abnormal tonic or clonic motor activity, apparent change of consciousness and autonomic manifestations, and an incorrect diagnosis of epilepsy may easily be made3. The medical literature on this subject is sparse’-5. We believe that our cases are examples of childhood masturbation4. Recently, Fleisher and Morrison3 outlined a number of characteristics of childhood masturbation in girls including: (1) stereotyped posturing involving tightening of the thighs, mechanical pressure applied to the suprapubic or pubic area, or both; (2) associated intermittent grunting, irregular breathing, facial flushing and diaphoresis; (3) episodes lasting between less than a minute and several hours; (4) no alteration of consciousness. Our cases share all of these characteristics. The posturing of the legs, the facial flushing, sweating and moaning, as well as the frequency and stereotypy of the episodes were all consistent with childhood masturbation. One clue to the diagnosis of masturbation in our cases was the stereotyped position of the legs during the spells as well as the fact that the episodes only took place when they were lying supine. Furthermore both patients were healthy children, normal at neurological examination and with no epileptiform activity recorded by electroencephalogram during the episodes. Antiepileptc treatment, even in high doses, given to case 1 was of no benefit. In case 2, there had been a preceeding illness of presumed viral encephalitis with some definite epileptic motor seizures and epileptiform abnormalities in the electroencephalogram. However, at the time when he presented with new symptoms his electroencephalogram, even during the attacks, was normal. We believe that infantile masturbation should be considered in the differential diagnosis of childhood epileptic seizures, in order to avoid unnecessary investigation and inappropriate treatment. The parents should be reassured that the episodes are benign and will eventually cease without any specific intervention.

DISCUSSION

Although the concept of early childhood masturbation was acknowledged more than 20 years ago’ this infantile autoerotic activity still causes considerable worry and unnecessary investigation and treatment2. The mas-

REFERENCES 1. Snyder, C.H. Nonepileptic fits in children. Postgraduate Medicine 1967; 42: 256-261.

Epileptic

fits or infantile

2. Bradley, Canadian

S.J. Medical

masturbation?

Childhood Association

201

female Journal

masturbation. 1985; 132:

1165-1166. 3. Fleisher, D.R. and Morrison A. Masturbation mimicking abdominal pain or seizures in young girls. Journal ofpediatrics 1990; 116: 810-814.

4. Bakwin, H. Erotic feelings in infants and young children. American Journal of Diseases of Children 1973; 126: 52-54. 5. Livingston, S., Berman, W. and Pauli, L.L. Masturbation simulating epilepsy. Clinical Pediatrics 1975; 14: 232-234.